Healthcare Provider Details

I. General information

NPI: 1467215541
Provider Name (Legal Business Name): KAITLYN SEDORCHUK-THOMPSON MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 E BIG BEAVER RD STE 107
TROY MI
48083-1430
US

IV. Provider business mailing address

409 E 9 MILE RD APT 322
FERNDALE MI
48220-3038
US

V. Phone/Fax

Practice location:
  • Phone: 248-250-6620
  • Fax:
Mailing address:
  • Phone: 313-284-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023401
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: